MEDICARE: DR. STEPHEN T PETTY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	24048	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518964675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN T PETTY MD

Provider Business Mailing Address
First Line	:	850 E HARVARD AVE
Second Line	:	SUITE 155
City	:	DENVER
State	:	CO
Zip	:	80210-5073
Country	:	US
Telephone Number	:	303-778-1910
Fax Number	:	303-698-2694

Provider Business Practice Location Address
First Line	:	850 E HARVARD AVE
Second Line	:	SUITE 155
City	:	DENVER
State	:	CO
Zip	:	80210-5073
Country	:	US
Telephone Number	:	303-778-1910
Fax Number	:	303-698-2694

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	09/25/2012

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